The Weekend Effect: Risks for Pediatric IBD Patients

Have you ever noticed that your quality of treatment in a hospital changes based on the time of day and/or the day of the week that you are there? It’s true; the care you receive during regular hours on a weekday can vary drastically from the weekend. This is often referred to as the weekend effectthe difference in health outcomes for patients in the hospital on a weekday versus a weekend.

According to an article on the Agency for Healthcare Research and Quality (AHRQ)’s website, there are several factors that play into the weekend effect, including:

  • Levels of staffing, i.e. less staff overall or fewer experienced/specialized staff
  • Access to specialized diagnostics or therapeutics, which can be delayed on the weekends
  • Severity of patient’s condition(s)

The weekend effect is known to impact gastrointestinal surgeries, causing an increase in complications during surgery, longer hospital stays, and higher costs for admissions on the weekend. Recognizing this, Drs. Matthew Egberg, Joseph Galanko, and Michael Kappelman hypothesized that pediatric IBD patients who are admitted on the weekend and require urgent intestinal surgery are at a higher risk for developing in-hospital complications as compared to those admitted during the week.

The results of their study, “Weekend Surgical Admissions of Pediatric IBD Patients Have a Higher Risk of Complication in Hospitals Across the US,” were recently published in Inflammatory Bowel Diseases and validated their prediction. 

Drs. Egberg, Galanko, and Kappelman analyzed data from 1997-2016 from the Kids’ Inpatient Database (KID), a nationally representative sample of pediatric hospitalizations created by the AHRQ. Specifically, they looked at pediatric patients (18 years or younger) with a confirmed diagnosis of Crohn’s disease or ulcerative colitis who had an intestinal surgery within 48 hours of admission.

The study included a total of 3,255 urgent weekend surgical hospitalizations and found that the most frequent complications for weekend pediatric IBD surgical admissions included:

  • Post-surgery intestinal and hepatic complications (28% for Crohn’s, 20% for ulcerative colitis)
  • Obstruction of the intestine due to paralysis of the intestinal muscle (16% for Crohn’s, 12% for ulcerative colitis)
  • Post-operative sepsis (12% for Crohn’s)
  • Post-operative infection (11% for ulcerative colitis)

The study found that there was a 30% increased risk for complications among Crohn’s patients and a 70% increased risk of complications among ulcerative colitis patients.

What this means

Simply put, this means that pediatric Crohn’s and ulcerative colitis hospitalizations requiring urgent surgery are at a higher risk of in-hospital complications when they occur on the weekend. More research is needed to understand all the factors that contribute to the weekend effect and help reduce the disparity between weekend and weekday surgical outcomes. 

Although the risk of complications may be higher on the weekend, it’s always better to seek medical attention right away instead of waiting for a weekday. There are a few things you can do to help advocate for your child if they do end up in the hospital on a weekend requiring intestinal surgery:

  • Make sure your child’s medication list and medical information is up-to-date in case you are working with different providers or a different medical system altogether
  • Contact your child’s doctor and surgeon to give them a heads up that you are heading to the hospital. You can also ask them ahead of time to walk you through the emergency department or at least explain what that visit might look like in the event that they have to go to the hospital for an unplanned surgery
  • Request a social work consult to assist with any concerns and/or paperwork

You can also check out our planning resources for pediatric patients and caregivers to help you become more prepared and informed in case of an emergency. 

Rebecca Kaplan is the Public Affairs and Social Media Manager for the Crohn's & Colitis Foundation and the caregiver of a Crohn's disease patient.